Ti On Review On The P example essay topic

In recent ye? rs medic? l costs? re est im? ted to? count for 40-50 percent of the n? ti on's workers com pens? ti on benefits, ? c cording to the N? ti on? l Council for Compens? ti on Insur? nce (NCC I). The group he? lt in sur? nce industry h's used utilize? ti on review (UR)? nd medic? l bill? ud it (MB?) for m? ny ye? rs?'s? cost-cont? invent mech? nis m. The workers com pens? ti on industry h's been slow to employ m? ny of the cost-cont? invent progr? ms th? t h? ve proven successful for group he? lt. Utiliz? ti on review is the term used for monitoring? p propri? tenets of hosp it? liz? ti on for p? tents in? hosp it? l. Most patients? re hosp it? lived while someone else p? ys the bill. Th? t someone w? nuts to be sure th? t the bill is not excessive or in? p propri? te.

Utiliz? ti on review c? n be performed either by the third-p? ray p? yer or by? dep? rtm ent of the hosp it? l. Frequently, the hosp it? l will contr? ct with the p? yer to perform the utilize? ti on review on the p? yer's be? lf. In? ll c? ses, the utilize? ti on review dep? rtm ent is usu? lay involved in tr? inform? ti on? bout the p? tien t to the p? yer. The inform? ti on usu? lay comes from document? ti on in the medic? l record.? p propri? tenets for hosp it? liz? ti on is judged on two grounds: severity of illness? nd intensity of service. In other words, the p? tien t h's to be sick enough to merit being in the? cute c? re hosp it? l setting ('s opposed to somewhere else)? nd the services the p? tien t needs c? n only be provided in the hosp it? l setting.? l though some p? yes try to c? ll the tre? ting physic i? n for? d dition? l? ti on? nd document? ti on, this is r? re (in p? rt be? use it is so h? rd to get the physic i? n on the phone). Most p? yes get their inform? ti on from the utilize? ti on review st? ff person re? ding the hosp it? l ch? rt.

Utiliz? ti on reviewers use? compendium of indic? tors for severity of illness? nd intensity of service. When the ch? rt is reviewed, or c? ll seeks for inform? ti on, they? re comp? ring th? t inform? ti on to the h? nd book from which they work. Topic? l h? nd book descriptions include? list of physiologic? l p? r? meters such's vs. it? l signs? nd di? gnostic / ther ? peu tic interventions. The h? nd books gene? lay do not cont? in? ny indic? tors rel? ted to complexity of decision m? king, over? ll severity of illness ('s opposed to me? sure's of die? se), f? milk distress, soci? l inst? , etc. Neither do the h? nd books specific? lay include indic? tors for the p? tien t who is imminently dying. Bec? use the utilize? ti on review guidelines do not directly describe? ctu? l p? tien t seen? rios, their interpret? ti on for? n individu? l c? se requires judgment.

This is? lay true for p? tents th? t m? y need the services of? p? ll i? time c? re progr? m. Therefore, it is critic? l th? t the p? ll i? time c? re te? m under st? nd the utilize? ti on review process, ? nd work with it. Utiliz? ti on review? b str? cts the inform? ti on in the medic? l ch? rt? nd tr? it to the p? yer. Therefore, it is key for the p? ll i? time c? re te? m to provide inform? ti on th? t utilize? ti on review needs.

During the 1990's?? tell 30st? tes, in? d dition to Kentucky, h? ve? d opted m? nd? tory or volont? ry UR? nd / or MB?? n? d dition? l seven st? tes h? ve? d opted UR's p? rt of m? n? ged c? re l? ws. (D? t? b? sed on? 50-st? te's umm? ry of workers com pens? ti on UR? nd m? n? ged c? re prep? red by the M? ss? Dep? rtm ent of Industri? l? .) In 1994 the Kentucky Gener? l? p's sed leg isl? ti on th? t subs t? nt i? lay reformed the system for the delivery of he? lt c? re benefits to injured workers. The reform required the? d option of fee schedules th? t would result in?

25 percent reduction in medic? l fees, permitted the form? ti on of m? n? ged c? re org? nik? t ions, m? nd? ted utilize? ti on review? nd medic? l bill? ud it, ? nd required design? ted physic i? ns to cordin? te medic? l c? re for injured workers. The Workers Compens? ti on? ct w's revised? nd?? time regal? t ions were? d opted to meet the objectives of improving medic? l tre? tent, reducing over utilize? ti on of services, reducing lit ig? ti on over medic? l m? tiers? nd f? ci lit? ting the exch? ng of inform? ti on between physic i? ns? nd p? yes.'s p? rt of the 1994 workers com pens? ti on reform, KRS 342.035 required the Commissioner of DWC to? te?? time regal? t ions governing medic? l provider utilize? ti on review? conducted by in sur? nce c? , group self-insurers, ? nd self-insured employers. To? ss ist in dr? f ting? UR? nd MB? regal? ti on, DWC formed? n? committee comprised of represent? times from the leg? l, medic? l, ? nd in sur? nce industries.